Risk Factors for Persistent Postsurgical Pain in Women Undergoing Hysterectomy Due to Benign Causes: A Prospective Predictive Study

Abstract

Persistent postsurgical pain (PPSP) is a major clinical problem with significant individual, social, and healthcare costs. The aim of this study was to examine the role of demographic, clinical, and psychological risk factors in the development of PPSP after hysterectomy due to benign disorders. In a prospective study, a consecutive sample of 186 women was assessed 24 hours before surgery (T1), 48 hours after surgery (T2), and 4 months after surgery (T3). Regression analyses were performed to identify predictors of PPSP. Four months after hysterectomy, 93 (50%) participants reported experiencing pain (numerical rating scale >0). Age, pain due to other causes, and type of hysterectomy emerged as significant predictive factors. Baseline presurgical psychological predictors identified were anxiety, emotional illness representation of the condition leading to surgery, and pain catastrophizing. Among the identified psychological predictors, emotional illness representation emerged as the strongest. Acute postsurgical pain frequency and postsurgical anxiety also revealed a predictive role in PPSP development. These results increase the knowledge on PPSP predictors and point healthcare professionals toward specific intervention targets such as anxiety (presurgical and postsurgical), pain catastrophizing, emotional illness representations, and acute pain control after surgery.Perspective: This study found that presurgical anxiety, emotional illness representations, and pain catastrophizing are risk factors for PPSP 4 months after hysterectomy, over and above age and clinical variables. These findings improve knowledge on PPSP and highlight potential intervention targets for healthcare professionals.

The First Postoperative Day

“…For instance, it has been shown that factors like presurgical anxiety, expected pain, and pain catastrophizing have predictive value for postoperative pain after otorhinolaryngologic or other kind of surgery. 14,15 The undersupply with adequate pain management after surgery is not a specific problem of otorhinolaryngologic surgery. It seems to be a general problem after any kind of surgery.…”

A Review of the Literature on Multiple Factors Involved in Postoperative Pain Course and Duration

“…38 A study of 56 patients undergoing thoracotomy found that 54% of patients reported chronic pain at a median of 25.5 months after surgery. 39 Of the 30 patients reporting chronic pain, pain was described as "constant" for 33%, "on and off" for 17%, "a few times per week" for 37%, and "a few times per month" for 13%.…”

Chronic postsurgical pain and neuropathic symptoms after abdominal hysterectomy

“…[5] Several factors, including intensities of preoperative and postoperative pain, the approach and type of surgery, and genetic factors, contribute to the risk of pain chronicity. [6] Nevertheless, limited information is available about pain chronicity after gynecological operations.…”